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1588666267

NPI Code Detail

MEDICARE: KEITH SHUTE MD

MEDICARE: KEITH SHUTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9083	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	RE7915	OTHER		MEDICARE GROUP PTAN
6	RE289602	OTHER		PTAN MEDICARE
9	P00100702	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9083	OTHER	NH	STATE LICENSE #
2	0109410YPNH02	OTHER	NH	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	3626045001	OTHER	NH	CIGNA HEALTHCARE
8	5830418	OTHER		AETNA GROUP

General Provider Information

NPI Number	:	1588666267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH SHUTE MD

Provider Business Mailing Address
First Line	:	133 PLEASANT ST
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-2006
Country	:	US
Telephone Number	:	603-752-2040
Fax Number	:	603-752-1709

Provider Business Practice Location Address
First Line	:	59 PAGE HILL RD
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-3531
Country	:	US
Telephone Number	:	603-752-2900
Fax Number	:	603-752-3727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	03/07/2023

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Practice Location Address:

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Directions to “ KEITH SHUTE MD” Practice Location

Language	Start Address	Practice Location

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